Tuesday, 10 November 2015

8757 or 8760 - What’s the Difference?

Diabetes is a self managed condition. You live with it 24/7 and make decisions about how to manage it during that time. If you’re lucky, you receive help, support and learning, both informal and formal, from your nearest and dearest, other people with diabetes, diabetes health services and organisations. But it’s still yours every day.

Campaigns like the recently launched ‘Taking Control’ by Diabetes UK highlight how important the education side of things is, helping people to understand more and learn the skills to make those daily decisions. ‘SD Comments’ has talked many times about the tiny numbers of people who actually receive such learning opportunities, even though they are recommended for everyone, So, we’re really pleased to see this campaign get off the ground, support it wholeheartedly, and wish it every success. There is just one thing, however…..

…and that is, the first sentence of the introduction to the campaign reads ‘..people with diabetes only spend around three hours with their doctor, nurse or consultant. For the other 8757 hours, they must manage their condition themselves’. This implies that when someone with diabetes is consulting, somehow the responsibility for their diabetes belongs to the health professional they are with.

It’s not deliberate, but this is another example of what might be called ‘unconscious paternalism’ – the idea that it’s ok for ‘patients’ to do their own thing unless they are under the jurisdiction (ie in the consulting room) of a health professional.

Apart from being at odds with the personalised care policy, the push for greater collaboration between health professionals and people with diabetes and promotion of self care, this assumption also makes the mistake of thinking that the health professional being consulted actually knows what is best for the person. They may be valued experts in diabetes, but not in living with diabetes and particularly not in an individual’s life with diabetes, not on that day, in that hour, or ever. Nor should they try or expect to be.

What’s needed is for this oft-trotted statistic to be reflected upon. Is this really what we want those numbers to mean? We suggest not. It’s perfectly valid to count the hours (or lack of them, some would say) that someone spends with a health professional, It’s also perfectly valid to consider how well these hours are used to promote and support self management and daily decision making. What’s not valid is to perpetrate the unconscious but well-rehearsed assumption, however well-meant, that really, it’s the health professional who matters most, who is somehow ‘in charge’

People with diabetes are perfectly capable of looking after their diabetes within a consultation as outside it, 8760/8760. The job of the consultation is to reflect and work together on the experiences these hours raise for the person themselves, so that they are equipped to make each one of them a success

Reference

Diabetes UK’s Taking Control Campaign

Tuesday, 20 October 2015

Should There be Sugar Everywhere?

The campaign to encourage the UK Government to tax sugary soft drinks stepped up a notch this week, with Jamie Oliver continuing his quest at the Houses of Parliament, first with the Health Select Committee and then with the All Party Parliamentary Group (APPG) on Diabetes. He reckons the tax will raise up to £1bn and also change the nations habits and choices towards low sugar varieties of fizzy drinks or water. Jamie’s leading by example in his own restaurants, by making sugary drinks more expensive than ‘diet’ varieties.

Whether this will even be adopted, much less work, remains to be seen. A new tax, particularly on a ‘pleasure’ related activity, may not be popular with the all-important voters. And might it smack of ‘nanny state-ism’, trying to organize the behaviour of the population, rather than allowing them to choose for themselves what is good for them and their families? Discussion boards are full: of ‘righteous restrainers’, who ask why they should pay more tax just because others cannot control themselves in relation to calories, as well as ‘generous gifters’, who see the benefits to all – dental, environment, economic – of a change in availability of so much sugar – and everything in between. Public opinion is divided.

On the other hand, it’s undeniable that we are in the middle of a resolutely ticking, weight-related time bomb, set to go off at any time and unleashing untold illness, misery, and expense to the NHS among middle aged and younger people. Some say there is a generation alive now, who will be the first to die before their parents, because of the wrath of Type 2 diabetes, cardiovascular disease and immobility, caused by excess calories, of which they are largely unaware because of (allegedly) limited labelling and ruthless marketing on the part of the giant fast food industries

How can these issues be resolved in the interests of everyone? One thing’s for sure, this will not be a ‘one solution fits all’ situation – tax sugary drinks and all will be well. Equally, we believe strongly that people are the best decision makers for themselves, given the information they need to weigh up their choices. So there needs to be a much wider range of information and approaches. Here are some of our ideas to contribute to a way forward:

The National Prevention Programme for Type 2 Diabetes needs to be heavily involved in messages about the seriousness of Type 2 diabetes and the possibility of its prevention, directed at everyone, rather than to those immediately at risk. There are still too many myths about Type 2, including ‘it comes on in later life’ and ‘it’s only the mild form’. The nation’s psyche in this respect needs all the help it can get to change.

Fast food, ready made food and drinks companies need to invest in much clearer labelling to help people make choices – Jamie Oliver’s suggestion that sugar content is shown in spoonfuls rather than grams, for example, would make much more sense to every buyer as they can envisage those spoonfuls being added.

Comparison tools (maybe linked to the self-scanners on trolleys or on the shop floors?) to be freely available in food stores . These would show the relative sugar content of different products by name, so that people can make on the spot choices while actually shopping. These comparator tools could also be online or even (remember the old ways?) in pictorial leaflet –form, but would be most important in-store, where the shopping head is in full control.

The answer to the question this blog poses? There can be sugar everywhere, but it doesn‘t mean we have to eat it. Other substances are also available – as long as we know it!


Reference

Be Bold on Sugar Tax, Jamie Oliver Says

Jamie Oliver meets with Diabetes UK at Parliament

Tuesday, 29 September 2015

Old Things in New Ways?

The promotion of self-management of diabetes by the person with the condition themselves is not new. As far back as the 1940s, when insulin was relatively new in town and medications for Type 2 diabetes were hardly thought of, a young doctor called Robin Lawrence wrote in his book ‘The Diabetic Life’ – ‘the patient must be at once his own doctor, dietitian and lab technician’. This urge and acceptance that diabetes is absolutely a self-managed condition somehow got lost over proceeding decades, when health professionals tended to take charge of both medications and expectations

More recently there’s been a massive upsurge in ‘people power’ in society generally. The expectation and indeed, often, political will, is that people will do things for themselves. We are our own cashiers in the supermarket, our own bankers and even our own hotel receptionists. This upsurge has been replicated in medicine, not least because most illnesses these days are the long term variety, such as diabetes, that people have to manage themselves each day. This is well recognised, being mentioned in health policy documents as well as official guidelines and enacted in practical situations such as GP’s clinics and hospital wards. Indeed, our own work here at SD is all about promoting success in living with diabetes

Given this situation, the news this week that a major international meeting of the great and the good of diabetes care and education, held here in the UK, had formed an alliance which resolved to make diabetes care more person centred and promote self management, would seem rather unnecessary. Surely things are going in the right direction already? Do we need another layer of ‘initiative’ in this direction?

The truth is, as we’ve no doubt said before, that there is a lot of TALK about promoting self-management and being person-centred, but often the ‘old ways’ – a rather paternalistic approach, people being ‘told off’ for not achieving text book results, scant regard for the emotional turmoil which many people experience their diabetes, etc etc – persist, even supported by protestations that ‘the patients need me to tell them what to do, otherwise they wouldn’t know’

Hence a new, eye-catching way of promoting this way of being in relation to helping people really run their own condition has got to be good. The words might not be new, but the actions could reflect new times to come. We await this Alliance’s progress with our full support

Talking of old and new, SD is changing its ways this week, too. 30th September 2015 sees the last issue of our monthly newsletter, which has been running since 2008. Our refreshed communication plan is to make much more use of the instant means available to us, to update much more often using the 21st century tools of social media, Facebook, Twitter and the like – and add more frequent, but shorter, comment on the blog here. The need to communicate is as old as the hills, but the ways of doing it can be ever newly minted!

References

The Diabetes Times: Alliance formed to promote diabetes self management

Tuesday, 18 August 2015

No Judgement Please – We’re Doing our Best!

Recently, two unrelated publications, one an Australian blog and the other a UK peer-reviewed medical journal, have given voice to the same topic. Their different and highly complementary views combine to offer a powerful message, close to the heart of many with diabetes as well as ours here at SD.

On 7th August, Renza Scibilia wrote her daily blog about living with diabetes as if it were a letter to a diabetes doctor in a new clinic. It started with the words ‘you and I are on the same side. My side’, then continued expressing the hope of partnership, of mutual understanding and the absence of judgement about her life with diabetes. Above all, she expressed the desire for recognition that even when diabetes isn’t going too well in her life, that she is always doing her best.

Her message is clear: respect my expertise and I’ll respect yours, so we can have a great and useful relationship. This post attracted a number of comments, including one from a diabetes educator who said ‘you have helped me become a better clinician’. It occurred to us that the idea of a ‘letter of introduction’ such as this, should perhaps be an option in all clinics, to help break down the assumptions, myths and negative judgements that, however inadvertently, often underlie the consultation words from a health professional towards and about the person with diabetes.

Which helps to introduce the second publication, from the respected journal ‘Diabetic Medicine’. In the first study of its kind, the authors interviewed parents of children with Type 1 diabetes about the challenges of keeping their children’s blood glucose in range, in the context of their everyday lives.

Apart from the surprise that such a qualitative study had not been undertaken before now, there were two major new findings in this paper – one being that parents often had ‘home’ and ‘away’ blood glucose targets – the latter being more relaxed than the former. This reflects the desire to ensure their child was safe from hypoglycaemia and able to enjoy the event they were attending without their parents. It also showed their recognition that other care givers at events would not have the detailed knowledge that they had about the intricacies of diabetes-related actions and their own child’s condition. This in itself was hugely moving, the parents wishing ‘a normal life’ for their child and reassurance for themselves that hypoglycaemia, an ever present fear for parents, was unlikely outside of their direct care.

The second finding was in relation to consultations with health professionals, who, although excellently reviewed in terms of knowledge of diabetes and its treatment, were universally found to expect a ‘text-book’ achievement of recommended HbA1c levels, without apparently realising the realities and complexities of life with diabetes that the parents had to face. It seemed to be summed up in the comment by one parent ‘you’ve tried really hard…and you get ‘oh their HbA1c is not good enough, you need to do better’. In this single sentence, the sense of demoralisation, frustration and unrecognised effort rings out.

Unsurprisingly, one of the conclusions of the paper is that health professionals need to be more empathic, more recognising of effort as well as results and have a training that engages in the everyday detail of living with diabetes as well as the medical and scientific knowledge which currently prevails.

What are we saying here by bringing these two pleas together? Quite a simple message really, one for health professionals as they invite people living with diabetes into their consulting rooms, and one which is really quite easy and cheap to achieve. It’s summed up by something a colleague of ours said many years ago ‘always remember to honour effort as well as outcomes’.

It’s only the sheer effort and doing their best by people who are in the complex maelstrom that diabetes can present in life, that gets any outcome at all. And the only judgement that effort deserves, is a massive ‘well done’ at each and every visit. Please, just do it.

References

Diabetogenic: Dear Doctor: 7 August 2015

Lawton, J., Waugh, N., Barnard, K., Noyes, K., Harden J., Stephen, J., McDowell, J., Rankin, D. (2015). Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents’ experiences and views. Diabetic Medicine , 32, 1063-1070

Wednesday, 29 July 2015

Type 2 - Time to Test?

Self monitoring of blood glucose (SMBG)for people with Type 2 is currently restricted, in both local and national recommendations, to those in all but very specific circumstances. We believe this is, at best, unfair and at worst, in complete contravention of current health policies which promote self-responsibility for health, self-management of long term conditions and individualised approaches to care. We believe that all people with Type 2 diabetes should be given the opportunity for SMBG. Here's why:

Type 2 diabetes is a progressive, serious condition which requires for many, considerable lifestyle changes if its dire consequences are to be avoided or detected promptly. For everyone, success in managing their condition depends on daily medication, physical activity, attention to timings, amounts and content of food and drink. Also required is effective and prompt action in the face of stress, illness, driving, holidays, work and social life, short-notice schedule changes, family responsibilities and more. In short, every aspect of daily life.

If people with Type 2 diabetes are to take their condition seriously by doing all this, as many in healthcare say they should, then they need the only practical tool available to them to help, namely SMBG.

1. But this is expensive, say health economists and budget holders: to which we say - but losing 20 years of your life to uncontrolled diabetes is also expensive, as is heart failure, amputation, kidney dialysis and blindness, which are among the most costly and avoidable consequences of not self-monitoring.

2. But people don't know how to use SMBG properly, say health professionals: to which we say - that's your fault for not explaining how it needs to be used and how serious a condition Type 2 diabetes is, and the need for rigorous self management, right from the start.

3. But there's no evidence it improves diabetes control or HbA1c, say researchers and medics: to which we say - most people with Type 2 diabetes aren't solely interested in their HbA1c, indeed many don't even know what this level is. What they are interested in is their everyday life and making this as hassle-free as possible, avoiding hypos and high blood glucose levels which can be inconvenient, embarrassing and even dangerous (e.g. when driving, as most people do). They also wish to see for themselves the positive effects of their strenuous efforts to make lifestyle changes and the choices they make daily, not wait 3 months for the health professional to order a repeat HbA1c.

If we are truly committed to a population of people with Type 2 diabetes effectively self-managing, they must have the tools to do this vital, cost-effective job. It's time to get people with Type 2 testing - or at least give them the choice.

Tuesday, 30 June 2015

When is Structured Education not Structured Education?


Back in March we praised a report by the All Party Parliamentary Group on Diabetes for their timely and important report on the state of diabetes education. We asked ‘what difference will this report make?’

It would appear that the jury is still out on that question, if Diabetes UK’s latest briefing report is anything to go by. Entitled ‘Diabetes Education: the big missed opportunity in diabetes care’, it explains that although diabetes education is recommended, it is hardly provided or attended. In a separate Diabetes UK survey, released for the recent Diabetes Week, 42% of people with Type 2 diabetes reported themselves to be unconfident about managing their condition.

It’s pleasing to see these messages being highlighted again, much as we and others have done many times in this blog and in other publications. We await the updated NICE guidance on Type 1 and Type 2 diabetes, to see if there is any emphasis at this level which could improve the situation for so many people with diabetes who are lacking the ‘tools to do the job’ of looking after a complex and at times, complicated, condition. Although, having seen the drafts of these guidelines, to be honest, we are not holding our breath here at Successful Diabetes! Diabetes UK are also campaigning for people to lobby their MPs about the issue, so we can hope that this personal approach brings much needed attention instead

So, whilst Diabetes UK’s briefing and its echo of many other calls to action in respect of the parlous state of diabetes education is welcome, we are bound to say that unfortunately it doesn’t tell the whole story in relation to the definition or availability of structured education. Here’s why:

It defines level 3, or structured, education solely in terms of group education. To our knowledge, there is nothing in the definition of structured education that says it has to be provided to groups of people. In fact, one of he earliest definitions of structured education, from the 2003 Technology Appraisal from NICE, says that it is ‘a planned and graded programme that is comprehensive in scope, flexible in content, responsive to an individuals clinical and psychological needs, and adaptable to his or her educational and cultural background’ (p 14). To be fair, the Appraisal mentions group education as being a principle, but also states ‘unless group work is considered unsuitable for an individual’ (p 4) and that ‘the aim of education for people with diabetes is to improve their knowledge and skills, enabling them to take control over their own condition’ (p 7). In defining structured education in this way, Diabetes UK have themselves missed an important opportunity to consider and acknowledge successful 1-1 structured education programmes, such as our own Diabetes Manual Programme.

As we’ve mentioned before, it’s rare that the Diabetes Manual Programme, a fully evidenced, educational intervention based on self-efficacy (otherwise known as confidence) principles, gets a look in, in such august reports. This needs to change, as the world has done so much since these early-cited documents were published.

Diabetes UK Briefing

Diabetes Manual Programme

Tuesday, 19 May 2015

Got diabetes? Welcome to the family

Our latest guest blog is from Joe Griffiths, on how finding the diabetes online community changed his life - and work!

I went 10 years before I started to look for outside help with my diabetes. Whilst I would keep my doctors and specialist nurses in the loop with how things were going sugar-wise, I kept the emotional side of things close to my chest. This was a mistake. Without realising, I was living with my diabetes like it was an embarrassing little brother. The kind you don’t want to bring to the party but feel like you have to because someone needs to look after him. He’ll pull on your arm when he needs attention or make a huff if you haven’t introduced him yet. He’s basically a needy little douche bag.

However, one day I randomly decided to take it upon myself to do some googling about online help for diabetes. What Google spat back at me was way more than I had anticipated. It wasn’t just the regular government supported sites taking up the first 10 spaces, instead there were links to blogs and online magazines. Unbeknown to me, there’s a whole community out there.

I immediately took to Twitter and searched for diabetes. Once again I found myself doing my best impression of a deer in headlights. I literally couldn’t believe my eyes! People were actually talking loud and proud about their diabetes, even mentioning it in their Twitter profiles. Once I had gotten over the initial shock, I began my own transformation…

In the space of a few weeks, I had more than doubled my Twitter follows and followers; connecting with my fellow pancreatically challenged brethren. I was instantly welcomed by several members of DOC (diabetic online community), introduced to different hashtags and tweet chats to help connect with others. Feeling like a member of an elite group; I even added ‘type 1 diabetic’ into my own Twitter profile!

After feeing inspired, I wanted to get it all off my chest. I put forward the idea of writing an article on diabetes, to my boss. As the lone diabetic at our company, Voucher Codes Pro, I’ve been at the butt of every sugar-based joke. It was time to clear a few things up about my condition and roll out some banter of my own...

The result?
One of the best pieces of content I had ever written. By injecting my own sense of humour, experiences and thoughts on diabetes, I had created a mammoth blog-type post on the dreaded D. I wanted to highlight how brilliant the DOC is and help educate those who may be newly diagnosed or completely clueless. By the time I had finished, it felt like a huge weight had been lifted from my shoulders. I was interacting with people who understood what I’d been going through the last 10 years, making them laugh while doing so.

The online community is fantastic. If you can take anything away from this, just give it a go and embrace your diabetes rather than seeing it as a curse (or an annoying younger sibling who you’re forced to take everywhere). I personally feel like a better person since having to take more responsibility for my well-being and I plan on continuing to improve myself well into the future.

We’re all in this together.

See Joe's website here

Tweet Joe @VCP_Joe

Monday, 27 April 2015

Listening to a Diabetes Diet – Food for Thought?

Radio 4’s ‘Food Programme’ focused yesterday on diabetes and food. A very welcome focus, stimulated in part, says the blurb, by the large number of people diagnosed with diabetes, contacting Diabetes UK to ask ‘what can I eat?’

The programme brought together an impressive line up of experts to discuss the answer to this question, including representatives from Diabetes UK, a media doctor whose own son has Type 1 diabetes, a specialist dietitian and a radio presenter with longstanding Type 1 diabetes. Together they were able to explain what diabetes is, how common is Type 2 diabetes and gave some good messages about what a healthy ‘diet’ consists of, including ways that less healthy options can be improved (with, generally, extra vegetables added). Particularly welcome was the news that Boots and Thorntons are phasing out their ‘diabetic’ food ranges and the emphasis by Diabetes UK on trying to get away from the idea of ‘a diabetic diet’

Although the focus was on food, as ever from an SD point of view, the most interesting aspects were the personal stories alluded to by those there to discuss actually living with diabetes. The media doctor described the challenges of helping a young child learn to live with daily injections and how even as a doctor, the emotional burden was the same as any parent would experience. He sounded clearly very proud of his now grown up son, (who has in turn become a GP) and relieved that he is living a very healthy life, something that will have resonated loudly with many parents of young children, and perhaps given them some consolation

JP, the radio presenter with Type 1 diabetes, described a huge family history of diabetes, much of it also Type 1. Even so, upon his own diagnosis, it had come as something of a shock to him what a juggling act it really was to live with this condition. He wasn’t so keen on eating out, he said, because historically it hadn’t been so easy to match his insulin timings to the food arriving. Even though times had changed, he still tended to follow what he’d been taught at the beginning, for example, eating as little sugar as possible

An item towards the start of the programme focused on someone newly diagnosed with Type 2 diabetes who in a relatively short interview, was able to reveal a range of concerns about having diabetes. This included finding unexpected amounts of sugar ‘lurking’ everywhere, for example, in tonic water, but more poignantly, the worries about passing on poor health to her sons and not wishing to ‘be a burden’ if she developed complications.

None of the personal aspects and emotional effects of living with diabetes were meant to be part of this programme, but they ‘leaked out’ anyway. Perhaps this is because food itself is an emotional issue for many people or perhaps, whatever the official topic under discussion, these are the aspects that matter most, as living with diabetes is so intricately bound within family and social relationships and our very identity. A programme putting this centre-stage would be a recipe for a very tasty listen.

BBC Radio 4: The Food Programme. 26.4.15

Monday, 13 April 2015

A suitable image for diabetes?

The news today carries an item about imagery for mental illness, with the organisation ‘Time to Change’ advocating a new way to portray those experiencing mental health issues, distress and despair. They suggest more neutral, supportive pictures, rather than the traditional ‘head in hands’ approach.

Being in total support of this, it made us think of the imagery that is used for portraying diabetes. Back in 2008, when Successful Diabetes was launched, we searched for a logo to show what our company aimed to achieve. You can see the finished article on our blog here, and also on our website. We’ve (thankfully) had many compliments over the years, especially in the vein of ‘it is so different to show diabetes as success story, it’s so often one of failure’.

But the logo wasn’t like this to start with. When we gave our name and ideas to the people designing the logo, the first suggestions focused on diabetes, complete with syringes, needles, finger pricks, plasters and doctors with stethoscopes round their necks. The ‘successful’ part of our name was pretty much ignored. After we gently pointed out that we didn’t want to focus on the medical, each new draft gradually featured such images less and less until, finally, there were none – which is just the way we like it!

Reflecting on this experience, it seems to show how ‘hardwired’ the images representing diabetes, seemed to be then. In turn, this made us wonder what images are tending being used to ‘show diabetes’ today. So, we had a (very unscientific) ‘straw poll’ of a few websites, and here is what we found:

Rather pleasingly, it looks like things have changed: even on the most ‘diabetes’ of websites (mentioning no names of course!), the images of people, whether living with diabetes or health professionals are really positive and realistic, with not a stethoscope in sight! Families are shown doing everyday activities, to represent coping with diabetes in the mix, happy groups of people on holidays seem to show that it is possible to enjoy life as well as having diabetes. There’s even a picture of people smiling, under the heading ‘hypos and how to cope with them’!!

A couple of aspects were noticeable, however. It seems that where research is discussed, there’s a universal tendency towards pictures of test tubes and white coated scientists with goggles on. Perhaps this stereotype hasn’t quite been attended to yet? and images of food, either under the banner of healthy or unhealthy, quite often feature a large burger and fries! This seems to be an extremely enduring, and all-purpose, image – we wondered if continuing to use it does more harm than good, but that is probably a blog for another day!

One website does deserve a mention because it seemed to use imagery consistently neutrally and successfully throughout. The International Diabetes Federation has a series of outline figures in different poses which give some really clear messages without any assumptions, and also showing that imagery can be made understandable in whichever language the website is accessed in.

What’s your image of diabetes? do you prefer the medical or the personal? The detailed or the vague? Do put us in the picture below!

Reference

Hawkins, K. Mental health and the death of the ‘headclutcher’ picture. ‘Ouch’ blog, 13.4.15

Monday, 30 March 2015

Is coming 4th out of 10 good enough for diabetes?

Late last week, NHS England published its business plan for 2015/16. It includes 10 priorities, of which ‘tackling obesity and preventing diabetes’ comes 4th, after improving, upgrading and transforming care for, respectively, cancer treatment, mental health & dementia and learning disabilities. It’s ahead, in the list of priorities, of urgent and emergency care, primary care, elective care, specialized care, whole systems care and foundations for improvement.

Of course, the list isn’t really about priorities of decreasing importance, all of these issues are of equal importance and will, we hope, receive equal attention, not to mention equal share of the some £2bn budget. Having a list of 10 makes it easier for people, including presumably NHS England staff and politicians themselves, to read and remember. It’s unarguable that all these issues need to be acted upon and also that system change is badly needed to address the early 21st century health ‘state of the art’. On that note, the business plan is to be welcomed and being 4th doesn’t mean losing out.

The targets for ‘tackling obesity and preventing diabetes', focuses on Type 2 diabetes (a detail unfortunately left out of the title) are ambitious for a year’s work. By March 2016, a prevention programme will be ‘available’ for 10,000 people at risk of Type 2 diabetes. NHS England will be working with Diabetes UK and Public Health England to develop the programme and roll it out, partly via the NHS Health Checks system. The plans are to ‘enroll’ people identified onto a lifestyle management programme to address their ‘smoking, alcohol intake, nutrition and physical activity’. The latter also applies to plans in priority 4 to also encourage these factors to be addressed by NHS staff themselves. It’s not clear if the latter will be among the 10,000 initial 'enrollees' or if there is to be a separate programme for healthcare staff.

While the forthcoming programme sounds admirable, we have a concern, based on the old saying ‘you can take a horse to water, but you cannot make it drink’. That is, it is one thing to ‘refer’ or ‘enroll’ people onto a lifestyle programme, but quite another to ensure attendance or participation. These the only things that are likely to make a difference to the health of the 10,000 souls to be identified. So, in the spirit of ‘4s’, we hope that the prevention programme in development includes this ‘top 4’ of evidence-based, vital components for success in encouraging lifestyle change:

1. ‘Invite’, ‘encourage’ or ‘welcome’ people to take part, rather than ‘refer', ‘enroll’, ‘send’ or any other paternalistic term that removes any suggestion of free choice
2. Focus on success and the future in interactive and participatory, enjoyable activities
3. Scrutinise the programme for, and remove any evidence of, judgement, tellings off, compliance-orientation, school or classroom-like environments
4. Prize autonomy, choice and personal decision-making

As we have said before, we wish this programme well and sincerely hope that this time next year, despite the election and our reservations, our blog will be trumpeting the success and ongoing delivery of type 2 diabetes prevention.

Reference
NHS England Business Plan

Sunday, 22 March 2015

Happiness is…..an ‘Emotional HBA1C’?

By Rosie Walker of Successful Diabetes and Jen Nash of Positive Diabetes

Last Friday was International Happiness Day, a very enjoyable-sounding occasion when the world’s happiness quotient is focused on. People were asked on TV stations, radio and around the world ‘what makes you happy ?’ and contributed such aspects of their lives as children, long walks, sunsets and chocolate cake! One report on the BBC showed a cafĂ© offering massage and laughter therapy to promote happiness!

All that may sound a bit trivial, obvious even, but there is a serious message behind the day, which is that more and more people, and younger people, report feeling lonely. Loneliness leads to isolation, low self esteem, a lack of self-worth and even feelings of not wanting to live anymore. It can also lead to physical ill health, which can all add up to a vicious circle of misery. Knowing this, the simple ways of trying to help make people happier, look much more important.

Happiness is also a factor in the ‘Emotional HBA1C’ – that’s HbA1c, but with the letters creating different meaning from the traditional. Recently, at Diabetes UK’s annual conference, we presented this emotional version, one where instead of being short for the medical terms ‘Haemoglobin’ and ‘A1c’, the letters stood for psychological factors which can also contribute to this all-important result, upon which so many decisions in diabetes care are made. However, these factors are often ignored in diabetes care services. We believe that being more aware of them can help people with diabetes and health professionals alike: Here’s what our HBA1C letters stood for, and why: .

Happiness: Being happier and relaxed – or, put another way, less stressed and distressed - can reduce blood glucose levels.
Balance: Looking after diabetes enough, in the face of all the pressures of ‘real life’, contributes to keeping a health balance which in turn influences blood glucose.
Attachment: Negative family experiences in early life can sometimes make it difficult later to look after diabetes and form relationships, including with health professionals. This might lead to less attention on diabetes care and, in turn, HbA1c.
1st things first: Being able to prioritise diabetes care, when it needs attention is likely to lead to better health. Diabetes can be thought of as a baby who demands the caregivers’ full attention, even when they are busy with something else. Working out how to look after the ‘diabetes baby’, however disliked, can positively affect the HbA1c result.
Curiosity: for the person to be curious about their own diabetes and identify the factors and strategies which work for them personally and they can cope with, makes a big difference to the end result of HbA1c.

For health professionals, these ‘emotional HBA1C’ factors give clues to how to create an environment in a consultation, meeting or education session, that pays attention and actively discusses how the person is coping emotionally as well as discussing the medical aspects. An example of a ‘health professional emotional HBA1C’ might look like this:

Help people to define their main issue of concern.
Be accepting of the person’s point of view.
Acknowledge feelings as well as practical content.
1 main idea or insight to take away from the encounter .
Concentrate on person’s agenda.

Our workshop was very well received and attended and we’ve created a full summary, including the participants’ reflections at the end and the slides we used to explain the ‘Emotional HBA1C’ in more detail and the evidence for it. We invited people to create their own ‘Emotional HBA1C’ of the aspects of diabetes they felt influenced the medical HbA1c, and use it in their life and work with diabetes. .

We invite you to download the workshop summary and we hope this new way of looking at HbA1c inspires you. If you decide to create your own ‘Emotional HBA1C’, perhaps you’d share it with us, here?

Wishing you happiness, today and for the future!

Positive Diabetes
Successful Diabetes

Friday, 6 March 2015

APPG for DSME - OK?!

Well done the All Party Parliamentary Group (APPG) for Diabetes! They have produced a report detailing the parlous situation and implications for people with diabetes of the gross lack of education provided to people when they are diagnosed, and beyond.

The report is concisely written and focuses on recent evidence about barriers to access to education, including the lack of provision of courses in general, and a ‘one size fits all’ approach to provision, in particular. It highlights the gap between services being rewarded for referrals to education through the Quality and Outcomes Framework, a system through which GPs are paid for their activities, and attendance by people at the courses. They conclude that this is often because people are not involved or engaged in the need for them to attend. .

The group gathered evidence from an admirable number of people living with diabetes themselves as well as clinicians, academics and diabetes organisations. This is to be congratulated and will probably give the report even greater credibility as well as those people being sure their voice has been heard. .

It’s a welcome addition, but only an addition, to the body of evidence that provision of opportunities for learning about diabetes are woefully inadequate and that diabetes services and commissioners alike seem to see training and education in the lifelong occupation of caring for diabetes by the person with it themselves, as a bolt-on ‘extra’ to clinical care. It makes recommendations, which are sound, but only an echo of what has already been said. .

The real question is ‘what difference will this report make?’ There are opportunities for clinical commissioning groups to provide courses in sufficient numbers and variety to meet their populations’ needs, but only if they also invest in a system which enables people to be told about them and be encouraged to attend. One of the main barriers to this cited in the report, is the attitude of referrers, who often have no knowledge or experience themselves of what education courses provide, nor their long term benefits. Hence, for many of them, a referral is a ‘take it or leave it’ affair and, in truth, a paper exercise. This must change if attendance at courses is to change and make it worthwhile for all those courses to be provided. .

Like most publications, the report is already in danger of being out of date, despite only being released a day or two ago. Updates to National Institute for Health and Clinical Excellence (NICE) guidance to the NHS for Type 1 diabetes, which are currently in consultation stage, propose to replace one of the documents to which the report refers. This is Technology Appraisal (TA) 60, which details what education programmes should be available. TA 60 was replaced for Type 2 diabetes in the last round of NICE guidance updates. Fortunately the new proposed guidelines for Type 1 diabetes, incorporate much of TA 60’s contents and also place provision of education as a priority for implementation. If adopted, these new updated recommendations should at least help to improve the picture, particularly if their implementation is closely monitored. We will have to ‘watch that space’, but for now at least a tiny further step has been taken to rectify this dire situation. .


Reference
All Party Parliamentary Group for Diabetes (2015). Taking Control: Supporting people to self-manage their diabetes. London. Diabetes UK (Sectariat) .

Tuesday, 17 February 2015

Type 2 in Adolescents: Make a Difference from the Start

Type 2 diabetes in children and adolescents is a growing phenomenon and a scary one. Complications can be linked to duration of diabetes and these young people still have a long time ahead of them when they are diagnosed aged under 18. Making their life with diabetes a healthy one is the great challenge, and this can only happen with their full knowledge and participation. Fortunately, research published this month in the respected journal 'Diabetic Medicine' gives some practical and important pointers as to how to achieve this.

The researchers asked adolescents with Type 2 diabetes directly about their beliefs, experiences, wishes and needs in relation to their condition and gained some important insights. For example, that the young people generally were not willing to tell their peers about their condition, for fear of judgement and bullying; that they wanted medications that were discreet and effective (tablets better than injections; injections of non-insulin products rather than insulin, because of their perception of its relationship with severity of diabetes and insulin leading to weight gain); that they would seriously consider bariatric surgery for weight loss. They also seemed to lack support from others, e.g. family members, when they would value reminders to help take medication and sharing in lifestyle changes.

One of the most striking findings was that the young people in the study did not seem to be overly concerned about their Type 2 diabetes or particularly aware of its progress or prognosis. Some of this seemed to originate with the familiarity of the condition through other family members having it, so it seemed 'normal' for them to be also diagnosed. Also, where family members did not make lifestyle or food changes, it was very difficult for them to do this on their own or see the importance of this. On the other hand, could some also be explained by them not receiving this information or it being emphasised enough during their care encounters with professionals?

Professionals are only just coming across such young people with Type 2 diabetes and there are few in any single clinic. Hence it may well be that they need particular guidance and skill development in how to proceed with their care. The paper helps with this as it is able to offer suggestions, based on the findings. These include:

Offering a whole range of medications that are likely to be effective and helping the young people to choose what is appropriate for them, bearing in mind that ease of timing, discreet application and benefits to weight are priorities they have expressed.

Sharing information about the implications of having diabetes, not only verbally, but offering further information about sources of information and support, which are available in ways that they might be willing to access - online, Apps, peer support forums.

Involving the family in supporting the young person and emphasising how this can help. This includes giving practical guidance about food 'swaps' at little cost and simple activity increase, such as walking.

Exploring the young person's own perception of what having diabetes means and how to share the information (or not) with their friends and peers. This could also include directing them to online support for young people experiencing peer issues, such as bullying, in any context.

This is a very practical list and we would venture to add the consideration of introducing young people with Type 2 diabetes to each other and supporting their discussions, informally or in a group discussion format (2 or 3 counts as a group), as well as helping them to learn ways of effective self management and strategies for confidence building and relaxation.

Like some of the other suggestions above, there may well need to be the involvement of some specialist workers, who support young people. This could be another valuable investment, as they can, in turn, perhaps help to 'up skill' diabetes practitioners to support the young people with Type 2 diabetes they will inevitably meet in future.

This paper gives a wonderful opportunity and practical insights into this vital and growing group of people and their needs. As ever, we will be doing our bit to broadcast its findings and contribute ideas for practical implementation. It's a timely chance for us all to 'start as we mean to go on' and really make a difference to their future.

Post-blog update

Hot on the heels of this blog post, we became aware of another paper about young people with Type 2 diabetes, this time from Australia and reporting work with young adults between 18 and 39. The authors compared a group of people of this age with the same number of older people also with Type 2 diabetes, and with the same number and age range of people with Type 1 diabetes. They investigated anxiety and depression levels, medication taking behaviour and healthy eating and physical activity levels.

They found that the young people with Type 2 had more depression and were less likely to eat healthily than older people with Type 2, less likely than the same age group with Type 1 diabetes to be physically active, and less likely than either of the other groups to take insulin as recommended. The authors conclude that these young adults with Type 2 have particular needs in relation to psychology and self-care support.

This evidence seems to add to our conclusion above about the importance of the 'support spotlight' falling on these young people and their challenges, who need to be seen as distinct from either others with Type 2 or their Type 1 counterparts. As the NICE (National Institute for Health and Clinical Excellence) UK guidelines for managing Type 1, Type 2 and Children and Young People with Diabetes are all currently being updated, this paper also offers brilliantly timed messages.

References

Turner, KA., Percival, J., Dunger, DB., Olbers, T., Barrett, T., Shield, JPH. (2015). Adolescents' views and experiences of treatments for Type 2 diabetes: a qualitative study. Diabetic Medicine, 32, 250-256

Browne, JL., Nefs, G., Pouwer, F., Speight, J (2015). Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) study. Diabetic Medicine, 32, 133-140

Thursday, 29 January 2015

Information Prescriptions for Diabetes - Backward or Forward Step?

At first glance, the information prescriptions for diabetes, launched this week, seem like a great idea. Take someone who attends their GP with blood glucose/cholesterol/blood pressure levels that don’t match the recommended targets and give them a takeaway - a bright, shiny A4 sheet describing how they can do better. Simple! And very quick, the all-important consideration for many hard pressed primary care professionals.

So that’s that problem solved, then.

The trouble is, as many of us know only too well, that a fix like this is highly unlikely to make much of a difference to the underlying reasons why someone might have these high levels – whether it’s because of the stresses of coping with difficult family or work circumstances (supporting your sister who’s ill with cancer, or looking after your grandchildren 3 days a week so your son can make ends meet with 3 jobs) or by actual choice (the schoolteacher of a class of 5 year olds who needs to make sure he doesn’t have a hypo during lessons).

We also know that ‘one size doesn’t fit all’. For some, the written word is easy and a pleasure, for others, torture and incomprehensible. And in any case, with all the other bits of paper that often accompany a medical appointment, will it see the light of day again from the pocket or bag it’s been placed in, once the person exits the building?

For many, information prescriptions will be offered after discussion and in response to specific questions that might be raised, and that is of course, the intention. However, for equally many others, they may be seen as a convenient way of ‘solving’ a clinical problem and ticking a box that flashes up on the computer screen – ‘this person needs an information prescription. Tick here when completed’. We hear that information prescriptions have been well received by people with diabetes and health professionals in the areas where the scheme was piloted. This is welcome news, but as is well-known, finding people to approve a development in a research situation and in ‘real life’, are not the same thing.

The medical model is one where people are told what to do by health professionals and expected to do it. This works really well for acute conditions, where there is relief in sight in quite a short time and / or the immediate consequences may be dire if instructions are not followed. For example, taking antibiotics for a severe infection that might otherwise result in hospital care being needed. To use a diabetes example, taking increased amounts of insulin with very high blood glucose levels during illness, to avoid life-threatening ketoacidosis in Type 1 diabetes.

The medical model is no good at all for helping someone live with a long term condition like diabetes, that depends mostly on self management, day in, day out. People with it need to make multiple daily decisions, choices and act accordingly, without a doctor or nurse’s say-so, or even in sight. The skills people need to make these decisions are usually not included in the ‘top down’ approach the medical model embraces.

Information prescriptions smack far too much of the medical model. What happens if people still have less than desirable (from the health professionals’ point of view) numbers next time, post-information prescription? Will they simply be issued with another, and another until they finally ‘obey’? or will they be cast out of the door, not to return until they have sorted themselves out to the satisfaction of the health professionals? Equally, what about those who would like the information contained in the prescriptions, but are ‘well controlled’? do they miss out on having their questions answered because they are not deemed ‘bad enough’ to qualify for an information prescription?

A way forward is not to medicalise even further, the encounter between someone living with diabetes and their health professional, when it comes to meeting the challenges of daily life. Rather, it’s to personalise things more. A really quick start to this, using the information prescription model, might be to have a message flashing up on the health professionals’ computer screen that incites them to congratulate a person who has achieved the recommended targets and discuss their success and how they might maintain it.

Thankfully, there is a model, which is gradually achieving recognition and implementation support in NHS circles. It’s known as personalised care planning, or PCP, which we’ve talked about and promoted on many occasions, as a system-wide solution to appreciating that people themselves are in charge of their condition and the choices they make each day are the only ones that will make a difference to the resulting ‘numbers’.

The job of the health professional in PCP is not to pontificate, order, tell, force or even cajole the person into submission to their will, but to share their ‘numbers’ with them and invite them to identify their own problem areas, goals and ways they wish to address them. Only through this process can they get anywhere close to addressing what, on the surface may look like a ‘non compliant diabetic’.

Information is everywhere and people can choose what works for them best. What’s needed is not a prescription, but a menu and support to explore it, and continued discussions of what’s worked in subsequent consultations. Fortunately, the idea of a local ‘menu’ is included in personalised care planning guidance recently published by NHS England, and is already being used in some areas. In the meantime, our own ‘SD Signposts’ is available for anyone to download and start to use, according, if they wish, to their personal learning style.

Health professionals may find more benefit from moving from information ‘prescribing’ to people with diabetes, to information ‘sharing’, which will be much more effective, not only for reducing the clinical ‘numbers’, but also frustration and time spent ‘telling’ – that’s our prescription for guaranteed satisfaction!

Monday, 26 January 2015

The Blueprint to Weight Loss?

In our first guest blog, clinical psychologist and specialist in emotional eating, Dr Jen Nash gives us plenty of ‘food for thought’!

We are in the midst of an overweight and obesity epidemic and whilst current health education messages are doing well to raise our awareness of the need to ‘eat less and move more’, we know for every person who can implement this advice, there are many more who struggle. This leads to a sense of failure and increased hopelessness, for both the individual who is overweight, and the healthcare professionals involved in their care, who quickly reach the limits of their perceived ability to help them.

Traditional medical and diet advice seems to treat weight loss as if it is a logical, rational process – for example, there is often an assumption that education alone leads to behaviour change. But knowledge doesn’t always lead to desired change, does it? How do we know this? Partly because many NHS health care professionals themselves struggle as much as those who they help – if not with their weight, then perhaps with their choices around alcohol, exercise, nicotine and other health decisions.

If we are increasingly aware of what we ‘should’ be doing to care for our health, what gets in the way of being able to implement these recommendations? Oftentimes we will sigh, “I’m just not motivated”.

I’d like to suggest that you ARE motivated! You don’t usually have to ‘motivate’ yourself to get dressed in the morning, or clean your teeth, or kiss your child goodbye, or turn up for work. You probably don’t talk about ‘getting motivated’ to do these tasks of life. Why? Because these activities are in line with your identity, your self-esteem and your values. You value your child feeling loved as they go to school, so you organise yourself to wave her off in the morning. You value not breathing your garlic breath from last night’s dinner on your colleagues, so you organise yourself to make time to brush your teeth in the morning!

So we are all motivated to do EXACTLY the right thing for us, given not just one, but two aspects of our experience:
1. Our knowledge + information
2. Our emotions + values

Medical and health educational models are great at the first part – imparting knowledge and information - but where in our health care settings are we talking about emotions and values?

These conversations are largely absent when it comes to discussing diet and weight loss, yet it is our emotions and values that are the bridge between ‘knowing something’ and ‘doing it’. These are the guide to all our decisions in life; including our decisions about our health and what to eat. Psychological models address emotions, but access to a clinical psychologist for people with obesity, whilst recommended by national guidelines, is extremely limited in current services.

‘The EatingBlueprint’ is a novel way for non-psychologists to start addressing the psychology of weight loss, without the jargon and potential stigma of some of the traditional psychological approaches. It is based on a blend of evidence-based psychological therapies (including solution-focussed, dialectical, compassionate, mindfulness, cognitive-behavioural and attachment approaches, for those who are interested in the detail!).

The logic of the blueprint is that trying to simply follow a diet to create the body/weight you want, without looking at the emotional ‘mindset’ about eating, is like trying to build a house before laying the foundations.. Strong foundations are needed to build a house – and a blueprint is needed as a guide. The EatingBlueprint is designed to support the development of the emotional mindset foundations necessary for both weight loss success and maintenance. To continue the analogy, the blueprint for the house’s foundations contains rooms, and in the EatingBlueprint, these ‘rooms’ are:

1. Forgiveness
2. Focus
3. Fun
4. Feelings
5. Foresight
6. Fables
7. Framework
8. Future
Let me talk you through the ‘rooms’

1. Forgiveness
The blueprint begins by normalising the idea that it is difficult to lose and maintain a healthy weight. We are fighting a biological, psychological and environmental/social world that is set up to promote weight gain, and the person is not “wrong” or “bad” for being overweight. This step is designed to provide relief from shame and stigma and set the scene for an approach that isn’t about success or failure, rather one that involves self-discovery.

2. Focus
This area aims to encourage the noticing and overcoming of “mindless” eating. While it is usual to eat mindlessly for non-hunger reasons occasionally, we can be helped by the use of strategies to interrupt frequent mindless eating. This can be encouraged using a simple question: “WHY am I eating?” or, simply, “WHY?” WHY is an acronym that stands for:

Wait
Remembering to pause before eating is challenging – so, in the short term, the person is invited to use a reminder on their dominant hand or wrist (e.g. a charity band - members of the EatingBlueprint receive a subtle wrist band as a reminder). This is just a short-term strategy until the automatic nature of eating becomes interrupted.
Hungry?
This invites the person to ask themselves, “Am I really hungry? How physically hungry am I, on a scale of 0–10? If I’m not hungry, what AM I hungry for?” (e.g. for a break, as a reward, for a distraction, to cheer myself up or to bond with someone).
Yes
This relates to saying ‘yes’ to the food or ‘yes’ to whatever the person is truly hungry for. If the person is physically hungry, this involves saying “Yes” to food and eating. If the person is not truly hungry and still eats, that’s okay too. Change takes time and the act of simply pausing brings an awareness to what was an unconscious process.

The power in this area is to help the person to discover what they are truly “hungry” for and ask themselves whether they can get their hunger met by something other than food. In time, they can begin to say ‘yes’ to this identified need, instead of the food.

The areas of the blueprint that follow are designed to help increase the flexibility to choose between a range of responses to food.

3. Fun
Eating is pleasurable and entertaining and it can become “a friend”. The person may need help to look for ways to increase non-food sources of pleasure and entertainment when there is an urge to eat for non-hunger reasons.

4. Feelings
It is common to use food to “stuff down” emotions that are not easy to express. It is a skill to be able to express emotions authentically to both ourselves and others and we often need strategies to express emotions rather than to dull them with food. The EatingBlueprint provides a template for identifying and expressing feelings in ways other than through food.

5. Fables
These are the family stories and rules about food, spoken and unspoken. Phrases like “eat your vegetables before having dessert” and post-rationing sayings such as “don’t waste food” and “finish everything on your plate” have value, but we need to question the modern day utility of these ideas and create more helpful narratives that serve us.

6. Foresight
To continue to maintain a healthy we need to know ourelves, learn from previous life experiences and manage their thinking styles relating to food. This step encourages the person to plan ahead and learn from the “predictability of life” (e.g. Christmas and meals out) and think about how to use this self-knowledge to experiment with new behaviours. It also invites the person to challenge the “good/bad” rules of diets using cognitive behavioural therapy techniques.

7. Framework
Weight loss isn’t a solo journey. The impact of family influence, the physical environment and handling social events are all crucial. The person needs assertiveness skills to be able to say “no” to the “feeders” in their lives, and to spot the signs of sabotage, often by well-meaning but threatened loved ones. The blueprint aims to provide these skills.

8. Future
Weight loss is a skill, yet we don’t treat it as being in this paradigm. Like learning to drive a car, it is a process that requires coaching and facilitation, and “mistakes” and “slipups” are an integral part of the journey that need to be welcomed. The blueprint teaches how to “update the default” and stay solution-focused on the weight loss journey.

The Psychology of Weight Loss in the NHS
None of the areas of the EatingBluprint are 'rocket science', so why aren’t we systematically addressing them? Arguably, because obesity is treated within a medical model, and considered a medical/educational problem, not an emotional or psychologically related one. NHS Clinical Psychologists and therapists are generally limited to offering structured cognitive behavioural therapy (CBT), in an individual or small group format, as recommended by UK national guidelines, so these ideas aren’t particularly available to staff to utilise.

Do people struggling with obesity need to work with a Clinical Psychologist? Controversially, I say perhaps yes, because there is quite a body of evidence that suggests many who routinely use food for emotional regulation have a history of psychological issues. The incidence of trauma, childhood abuse, sexual abuse, low self-esteem and depression is high among people who are obese and in those presenting for weight loss surgery. Despite this, access to psychological services for obese people has been limited to screening for psychiatric disorders in preparation for bariatric surgery.

Whilst certainly surgery is an option for some, if we view obesity as (in part) a problem with emotions, then bariatric surgery is attempting to put a plaster on a very deep emotional wound. This may go some way to explain why this type of surgery is less successful than expected. Achieving and maintaining a healthy weight requires skills of emotional regulation and the ability to tolerate distress - in other words it takes a highly developed person. We need to widen the scope of clinical psychology and other health professionals working in the field of obesity, to empower people with:
• skills to be able to identify their emotions
• strategies to make a choice other than food

So the person is in control, not the food

Interested in finding out more about the EatingBlueprint?

The EatingBluerint is a 12-week online weight loss support programme, that empowers members to master their inner relationship with eating, through bitesize videos (10-30 mins each) with accompanying ‘experiments’ to implement new weight loss skills in daily life. If you’re someone struggling to lose weight, or a health care professional interested in using the EatingBlueprint method in your routine consultations, you can get your Free E-Course – ‘Why the F*** Are We So Fat?!’ by visiting the PsychBody website

Training workshops in the EatingBluperint Method can be organised by contacting Dr Jen Nash, Clinical Psychologist directly at hello@psychbody.com or via enquiries@successfuldiabetes.com

What do you think of Dr Jen’s ideas? Share your response and insights here and let’s discuss this important issue and this unique way of looking at it

Wednesday, 21 January 2015

Designer Diets - or Common Sense?

The recent BBC series investigating personalised diets made fascinating watching and seemed like very good science. People were tested for the type of eater they were and then asked to follow a diet that addressed their particular type. Briefly, the three types of eater were ‘emotional’, ‘constant craver’ and ‘feaster’. The people involved in the experiment seemed more than happy to accept their ‘diagnosis’ and all of them successfully lost weight.

More than that, there seemed to be a palpable sense of relief among the participants that there was a ‘real’ cause for them being overweight. For example, in the case of the ‘feaster’ group, there was an actual hormonal inbalance, which was demonstrated to be corrected with the recommended eating programme. For ‘constant cravers’, their genes played a large role, and ‘emotional eaters’ often had experienced loss or deprivation or developed particular meanings for food, that eating or ‘comfort eating’ helped them to deal with. For us, this was a real highlight. So often, being overweight or trying to lose weight is fraught with other peoples’ judgment, criticism or ‘quick fix’ answers, which can add to an already present sense of failure and self-blame and makes shedding the pounds much harder to achieve.

We don’t know if there was anyone with diabetes in the study – probably not, as those with existing medical conditions may well have been excluded for valid research reasons – but it occurred to us that the recommendations for each of the groups would be equally safe, even ‘generalisable', for anyone wishing to lose weight, whether to enhance their diabetes management or to prevent getting Type 2 diabetes, regardless of what type of eater they are.

This is where the ‘common sense’ bit comes in. All the diets and tips recommended in the programme are not the proverbial ‘rocket science’, but well known and tried and tested ways to lose weight, which have already worked for millions of people, regardless of their ‘eating type’.

You can take the BBC online test on the programme website to identify your eating type and read more about the whole project. However, it’s completely possible, as in our case when we took the test, that you don’t fit exactly into any category. Maybe, there is also a ‘mixed eater type’ group, where you recognise elements of each eating type in yourself, perhaps at different times in your life?

In this case, there may be a danger that the success of this programme and its findings that there may be a ‘designer diet’, might have the opposite effect and put those of us in the possible mixed category above, off dieting altogether, perhaps by creating a response such as ‘there’s no diet that will help me lose weight, so it’s not going to happen and so I might as well not bother trying’?

The truth is, that if you aren’t able to, or don’t want to, know which type of eater you are, but you do still want to lose weight, you may well benefit from the plans put forward for all of groups. So, while we celebrate the success of this new way of looking at losing weight and look forward to its follow-on findings, there’s also the equally massive message - don’t let not knowing your ‘eating type’, or not belonging to a particular designer group, put you off!

We’ve set out the principles that were recommended for the groups and in general below, so you can take your pick and give them all a try if you want, to see what combination works for you. There will be one!

For added motivation and inspiration, you might find our booklets ‘Tips for a Lively 2015’ and ‘How to Make your Healthy Living Wishes a Reality’ both useful and inspiring. They are completely free and available to download from our website now!

Principles for successful losing weight (brackets show the particular group a principle might help most)

• Always eat breakfast – can reduce cravings later in the day
• Eat slowly – helps your body tell your brain when you are full, via hormones (Feasters)
• Eat high glycaemic index foods – again helps to feel full for longer (Feasters and Constant Cravers)
• Get support from others – online, face to face or in groups (Emotional Eaters)
• Gain insight into what food and eating means for you and how you behave around food, including professional help if you need it (Emotional Eaters)
• Eat soup – helps to feel fuller - and very comforting!
• Try Intermittent Fasting – minimum 600 and maximum of 800 calories on each of 2 consecutive days a week and eating normally, but healthily as possible, for the rest of the week – stops you feeling ‘deprived’ of food (Constant Cravers)

Wishing you success in your dieting plans, whatever they involve!

Friday, 2 January 2015

Promoting Prevention

Wonderful news to start the year! NHS England's implementation intentions for the 'Five Year Forward View', the latest plan for the NHS, include a national prevention programme for Type 2 Diabetes. Work on this is to begin imminently this year and will be developed and delivered in partnership with Diabetes UK.

It's a hugely important development that yes, could save taxpayers' money through less burden on the NHS, but more importantly, save people themselves the emotional stress and further physical ill health that diabetes can bring. As someone with Type 2 diabetes once memorably told us, 'Type 2 diabetes doesn't come alone to the party, it also brings its friends'- unwelcome friends as it turns out, which include high blood pressure, raised cholesterol, heart, foot and eye problems.

Prevention has been shown to work. Identifying and making people aware they are at risk is the first step and to an extent, this is already being done in the form of the NHS health check. A prevention programme will build on this and actually DO something about the risk. Hopefully, people at risk will be given individual, practical and most importantly, motivating, support and opportunity to do what's needed, that is to become more active each week and to lose some excess weight if they have any. Granted, that can be hard for some people, but not nearly as hard as trying to deal with those unwelcome 'friends' at the diabetes party, further down the line.

We sincerely wish this programme every success, will be watching its evolution carefully and stand ready to promote its delivery. Happy 2015!